CC exam 1 (ch 11, 12, 13, 14, 15)
13. How can pulsus paradoxus finding be assessed on the bedside monitor?
A decrease of more than 10 mm Hg in the arterial waveform during inhalation
18. The nurse is developing a patient education plan for the patient with endocarditis. What information would be included in the plan?
A long course of antibiotics is needed to treat this disorder.
22. What are the two important proteins contained within the cardiac cells that contribute to contraction?
Actin and myosin
15. What is the formula for calculating mean arterial pressure (MAP)?
Adding the systolic pressure and two diastolic pressures and then dividing by 3
21. A patient suddenly develops a wide QRS complex tachycardia. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which of the following interventions would be best to try first?
Adenosine 6 mg rapid IV push antidysrhythmic agent that remains unclassified under the current system
18. Which intervention should be strictly followed to ensure accurate cardiac output readings?
Administer the injectate within 4 seconds during inspiration.
13. A patient is admitted with hypertrophic cardiomyopathy. The nurse would expect the medical management of this patient to include which intervention?
Administration of beta-blockers
21. A patient is admitted with right- and left-sided heart failure. The nurse's assessment reveals that the patient has 3+ pitting edema on the sacrum, blood pressure of 176/98 mm Hg, and bilateral crackles in the lungs. The patient is experiencing shortness of breath and chest discomfort. Increased afterload is probably present related to the patient's blood pressure. Which therapeutic measure will most likely decrease afterload in this patient?
Administration of vasodilators
33. Why is the measurement of the QT interval important?
An increasing QT interval increases the risk of torsades de pointes.
66. What is the effect of preload on cardiac output?
As preload increases, cardiac output increases until it overstretches the ventricle and cardiac output decreases.
29. What two medications are commonly prescribed at discharge for patients who have had a coronary artery stent placed?
Aspirin and prasugrel Because platelet activation is a complex process involving multiple pathways, combination therapy with two or more agents has proven most effective.
5. The nursing management plan for a patient with angina would include which intervention?
Assessment and documentation of chest pain episodes
32. What does the P wave component of the electrocardiographic waveform represent?
Atrial depolarization
25. Which cardiac biomarker is elevated in decompensated heart failure?
B-type natriuretic peptide (BNP)
8. What is the most common complication of fibrinolytic therapy?
Bleeding
15. Through what mechanism does enalapril decrease blood pressure?
Block the conversion of angiotensin I to angiotensin II
16. Which statement regarding the autonomic nervous system's role in the regulation of heart rate is true?
Both sympathetic and parasympathetic influences are normally active.
31. A patient is admitted after a positive exercise treadmill test with a diagnosis of coronary artery disease (CAD) and stable angina. Radiographic tests show that the patient has blockage in the left main coronary artery and four other vessels. The nurse anticipates that the patient's treatment plan will include what treatment or procedure?
CABG Early studies demonstrated coronary artery bypass graft (CABG) surgery was more effective than medical therapy for improving survival in patients with left main or three-vessel coronary artery disease and at relieving anginal symptoms.
28. Patient is admitted with heart failure. The patient has developed dyspnea with wheezing, a nonproductive cough, and pulmonary crackles that progress to the gurgling sounds of pulmonary edema. The nurse suspects the patient may be developing with problem?
Cardiac asthma
23. A patient's bedside electrocardiogram (ECG) strips show the following changes: increased PR interval; increased QRS width; and tall, peaked T waves. Vital signs are temperature 98.2° F; heart rate 118 beats/min; blood pressure 146/90 mm Hg; and respiratory rate 18 breaths/min. The patient is receiving the following medications: digoxin 0.125 mg PO every day; D51/2 normal saline with 40 mEq potassium chloride at 125 mL/h; Cardizem at 30 mg PO q8h; and aldosterone at 300 mg PO q12h. The practitioner is notified of the ECG changes. What orders should the nurse expect to receive?
Change IV fluid to D51/2 normal saline and draw blood chemistry.
3. Which diagnostic test is most effective for measuring overall heart size?
Chest radiography
17. Which clinical manifestation is usually the first symptom of peripheral arterial disease (PAD)?
Cramping when walking
16. What is the physiologic effect of left ventricular afterload reduction?
Decreased systemic vascular resistance
6. What is one hemodynamic effect of a pericardial effusion?
Decreased ventricular filling
27. A patient was admitted 3 days ago with an acute myocardial infarction (MI). The patient complains of fatigue, not sleeping the past two nights, and change in appetite. Based on these findings the nurse suspects the patient may be experiencing which problem?
Depression
9. Which mechanism is responsible for the augmentation of coronary arterial blood flow and increased myocardial oxygen supply seen with the intraaortic balloon pump?
Diastolic inflation with retrograde perfusion
2. What places a patient with heart failure at risk for hypomagnesemia?
Diuretic use
24. A patient with a potassium level of 2.8 mEq/L is given 60 mEq over a 12-hour period. A repeat potassium level is obtained, and the current potassium level is 3.2 mEq/L. In addition to administering additional potassium supplements, what intervention should now be considered?
Drawing a serum magnesium level
7. Which finding is a reliable indicator of reperfusion after fibrinolytic therapy?
Dysrhythmias
A patient is admitted with an acute myocardial infarction (MI). What common complication should the nurse anticipate in this patient?
Dysrhythmias
50. Which diagnostic tool can be used to detect structural heart abnormalities?
Echocardiogram
9. What are the clinical manifestations of right-sided heart failure?
Elevated central venous pressure and sacral edema
30. A patient is admitted with a fever of unknown origin. The patient is complaining of fatigue, malaise, joint pain, and shivering. The patient's vital signs include temperature, 103° F; heart rate, 90 beats/min; respiratory rate, 22 breaths/min; blood pressure, 132/78; and oxygen saturation, 94% on 2L nasal cannula. The patient has developed a cardiac murmur. The nurse suspects that the patient has developed which problem?
Endocarditis
30. Which anticoagulant enhances the activity of antithrombin III and does not require activated partial thromboplastin time (aPTT) or activated clotting time (ACT) monitoring?
Enoxaparin enhances activity of antithrombin III, a more predictable response than heparin, because enoxaparin is not largely bound to protein.
24. A patient is admitted after a femorotibial bypass graft. What nursing action is critical in the immediate postoperative period?
Frequent pulse checks to the affected limb
25. A patient has been newly diagnosed with stable angina. He tells the nurse he knows a lot about his diagnosis already because his father had the same diagnosis 15 years ago. The nurse asks him to state what he already knows about angina. Which response indicates the need for additional education?
He can no longer get a strong back massage.
9. A patient is admitted with a diagnosis of "rule out myocardial infarction." The patient reports midchest pressure radiating into the jaw and shortness of breath when walking up stairs. When inspecting the patient, the nurse notes that the patient needs to sit in a high Fowler position to breathe. The nurse suspects the patient may be experiencing what problem?
Heart failure
5. Which criteria are representative of the patient in normal sinus rhythm?
Heart rate, 88 beats/min; rhythm regular; PR interval, 0.18 second; QRS, 0.06 second
2. Which value, when elevated, places the patient at lowest risk for coronary artery disease (CAD)?
High-density lipoproteins (HDLs)
53. Which blood test standardizes prothrombin time (PT) results among worldwide clinical laboratories?
INR
8. When assessing a patient with PVCs, the nurse knows that the ectopic beat is multifocal by what characteristic?
In various shapes in the same lead
26. The patient is 72 hours postoperative for a coronary artery bypass graft (CABG). The patient's vital signs include temperature 103° F, heart rate 112, respiratory rate 22, blood pressure 134/78 mm Hg, and O2 saturation 94% on 3L nasal cannula. The nurse suspects that the patient has developed what problem?
Infection and notifies the physician immediately
19. Why is mixed venous oxygen saturation (SVO2) monitoring helpful in the management of the critically ill patient?
It can detect an imbalance between oxygen supply and metabolic tissue demand.
23. Which laboratory value indicates a heightened risk for the development of coronary artery disease (CAD)?
LDL cholesterol level >190 mg/dL
36. A patient returns from the cardiac catheterization laboratory after angioplasty and stent placement (ECG changes had indicated an inferior wall myocardial infarction in progress). Which lead would best monitor this patient?
Lead II
17. What parameter is used to assess the contractility of the left side of the heart?
Left ventricular stroke work index
6. An assessment finding of pulsus alternans may indicate evidence of what disorder?
Left-sided heart failure
14. When assessing the pulmonary arterial waveform, the nurse notices dampening. After tightening the stopcocks and flushing the line, the nurse decides to calibrate the transducer. What are two essential components included in calibration?
Leveling the transducer to the phlebostatic axis and opening the it to air
68. The patient's admitting 12-lead ECG shows wide, M-shaped P waves. What diagnosis could be responsible for this finding?
Mitral stenosis
23. Which calcium channel blocker is beneficial in the treatment of patients with coronary artery disease or ischemic stroke?
Nicardipine first available intravenous calcium channel blocker and as such could be more easily titrated to control blood pressure
46. After a myocardial infarction, a patient presents with an increasing frequency of premature ventricular contractions (PVCs). The patient's heart rate is 110 beats/min, and electrocardiogram (ECG) indicates a sinus rhythm with up to five unifocal PVCs per minute. The patient is alert and responsive and denies any chest pain or dyspnea. What action should the nurse take next?
Notify the physician and monitor the patient closely.
7. What characteristic is associated with junctional escape rhythms?
P wave may inverted or absent
10. Which portion of the electrocardiogram (ECG) is most valuable in diagnosing atrioventricular (AV) conduction disturbances?
PR interval
19. When analyzing the electrocardiogram (ECG) strip of the patient with a pacemaker, the nurse notices there is a spike before each QRS complex. What is this phenomenon indicative of?
Pacing artifact; the pacemaker is sensing and capturing
19. A patient is admitted with an acute inferior myocardial infarction (MI). A 12-lead electrocardiogram (ECG) is done to validate the area of infarction. Which finding on the ECG is most conclusive for infarction?
Pathologic Q waves
25. When is a patient a candidate for a surgical repair of an abdominal aortic aneurysm (AAA)?
Patient experiencing symptoms
28. What is the preferred initial treatment of an acute myocardial infarction?
Percutaneous coronary intervention (PCI)
8. Assessment of a patient with pericarditis may reveal which signs and symptoms?
Pericardial friction rub and pain
21. A patient was admitted 3 days ago with a myocardial infarction. The patient is complaining of increased chest pain when coughing, swallowing, and changing positions. The nurse hears a systolic scratching sound upon auscultation of the apical pulse. Based on the symptoms, the nurse suspects the patient may have developed what condition?
Pericarditis
10. What parameter must be assessed frequently in the patient with an intraaortic balloon in place?
Peripheral pulses distal to the insertion site
12. The nurse is caring for a patient with left-sided heart failure. The nurse suspects the patient is developing pulmonary edema. Which finding would confirm the nurse's suspicions?
Pink, frothy sputum
4. A patient reports feeling dizzy after standing quickly. Which finding could provide a clue regarding the cause?
Poor skin turgor with extended tenting
20. A patient is undergoing ventricular pacing via a transvenous pacing lead. The nurse notes a pacing artifact, but it is not followed by a QRS on the electrocardiogram (ECG) monitoring. Which nursing intervention may correct this situation?
Position the patient on the left side
37. The patient's admitting 12-lead ECG shows tall, peaked P waves. What diagnosis could be responsible for this finding?
Pulmonary edema
9. What major clinical finding is present with ventricular fibrillation (VF)?
Pulselessness
22. Which of the electrocardiogram (ECG) findings would be positive for an inferior wall myocardial infarction (MI)?
Q waves in leads II, III, and aVF
2. Which hemodynamic alteration is the most common cause of a decrease in cardiac output in the postoperative cardiovascular patient?
Reduced preload
5. What is the rationale for administrating a fibrinolytic agent to a patient experiencing acute ST-elevation myocardial infarction (STEMI)?
Restoration of blood flow via lysis of the thrombus
17. A patient is admitted with a diagnosis of acute myocardial infarction. The monitor pattern reveals bradycardia. Occlusion of which coronary artery most likely resulted in bradycardia from sinoatrial node ischemia?
Right
2. The abdominojugular reflux test determines the presence of which disorder?
Right ventricular failure
11. Which findings would be reasons to abort an exercise stress test?
ST segment depression or elevation
39. A new-onset myocardial infarction (MI) can be recognized by what electrocardiogram (ECG) change?
ST segment elevation
52. What type of atrioventricular (AV) block can be described as a gradually lengthening PR interval until ultimately the final P wave in the group fails to conduct?
Second-degree AV block, type I
1. Which structure is the primary or natural pacemaker of the heart?
Sinoatrial node
22. Which classification of dysrhythmia is most common with an inferior wall infarction in the first hour after ST segment elevation myocardial infarction (STEMI)?
Sinus bradycardia
14. A patient is admitted with left-sided heart failure and a blood pressure of 220/118 mm Hg. Which drug will be most effective in decreasing the blood pressure and reducing afterload?
Sodium nitroprusside potent, rapidly acting venous and arterial vasodilator, particularly suitable for rapid reduction of blood pressure in hypertensive emergencies and perioperatively
15. A patient has been admitted in hypertensive crisis. Which medication would the nurse expect the practitioner to order for this patient?
Sodium nitroprusside requently the first drug used to lower blood pressure in hypertensive emergency
4. Which statement regarding the difference between stable and unstable angina is accurate?
Stable angina responds predictably well to nitrates.
3. The nurse is caring for a patient with these vital signs: blood pressure 220/110, pulse 108, respiratory rate 24, temperature 103° F, and oxygen saturation of 94% on oxygen 2L nasal cannula. The patient is responsive and denies chest pain. The physician has ordered a work-up for coronary artery disease (CAD). These findings are suggestive of which diagnosis?
Stage 2 hypertension
10. Which intervention is an essential aspect of the patient teaching plan for the patient with chronic heart failure?
Stressing the importance of compliance with diuretic therapy
56. A positive signal-averaged electrocardiogram (ECG) indicates that a patient is at risk for what problem?
Sudden cardiac death
14. The nurse is developing a patient education plan for a patient with valvular heart disease. Which instruction would be included as part of that plan?
Take prophylactic antibiotics before undergoing any invasive procedure.
1. A patient with a serum potassium level of 6.8 mEq/L may exhibit what type of electrocardiographic changes?
Tall, peaked T waves Normal serum potassium levels are 3.5 to 4.5 mEq/L
16. Which description best describes the pain associated with aortic dissection?
Tearing in the chest, abdomen, or back
18. A patient is connected to an external temporary pulse generator. What does the sensitivity control regulate?
The ability of the pacemaker to detect the heart's intrinsic electrical activity
4. How does a percutaneous transluminal coronary angioplasty (PTCA) improve blood flow?
The balloon stretches the vessel wall, fractures the plaque, and enlarges the vessel lumen.
3. Why do many patients with heart rates greater than 120 frequently have chest pain and shortness of breath?
The decreased diastolic time decreases oxygen delivery to the myocardium.
40. To accurately measure the heart rate of a patient in normal sinus rhythm, which technique would be the most accurate?
The number of small boxes between QRS complexes divided into 1500
20. A patient is admitted with right- and left-sided heart failure. The nurse's assessment reveals that the patient has 3+ pitting edema on the sacrum, blood pressure of 176/98 mm Hg, and bilateral crackles in the lungs. The patient is experiencing shortness of breath and chest discomfort. On the basis of this information, how would the nurse evaluate the patient's preload status?
The patient is experiencing heart failure and has too much preload.
38. A nurse is obtaining the history of a patient who reveals that he had a myocardial infarction (MI) 5 years ago. When the admission 12-lead electrocardiogram (ECG) is reviewed, Q waves are noted in leads V3 and V4 only. Which conclusion is most consistent with this situation?
The patient may have had an anterior MI.
1. Which statement about coronary artery disease (CAD) is accurate?
There is an association between development of specific risk factors and CAD.
22. Why are vasopressors used cautiously in the treatment of critical care patients?
They increase afterload.
11. Which statement regarding beta-blockers is correct?
They result in bronchospasm and should not be used in patients with chronic obstructive pulmonary disease (COPD).
26. A patient presents with severe substernal chest pain. The patient exclaims, "This is the most severe pain I have ever felt!" The patient reports that the pain came on suddenly about 2 hours ago and that three sublingual nitroglycerin tablets have not relieved the pain. The 12-lead electrocardiogram (ECG) reveals only the following abnormalities: T-wave inversion in leads I, aVL, V4, and V5; pathologic Q waves in leads II, III, and aVF; ST segment elevation in leads V1, V2, V3, and V4. Which statement is accurate about this patient?
This patient is having an acute anterior wall infarction.
12. Adenosine is an antidysrhythmic agent that is given primarily what reason?
To convert supraventricular tachycardias
29. A patient is admitted for palliative care for end-stage heart failure. What is the nurse's primary goal when caring for this patient?
To manage symptoms and relieve pain
16. Noninvasive emergency pacing is best achieved via the use of which type of temporary pacing?
Transcutaneous
24. A patient with coronary artery disease (CAD) is admitted with chest pain. The patient is suddenly awakened with severe chest pain. Three nitroglycerin sublingual tablets are administered 5 minutes apart without relief. A 12-lead electrocardiograph (ECG) reveals nonspecific ST segment elevation. The nurse suspects the patient may have which disorder?
Unstable angina
6. What cardiac influence ability to response to causes the patient to have symptoms with atrial flutter?
Ventricular response rate
7. What dysrhythmia is most frequently associated with sudden cardiac death?
Ventricular tachycardia
3. A patient has an implantable cardioverter defibrillator (ICD) for chronic ventricular tachydysrhythmias. What action should the nurse take when the patient's rhythm deteriorates to ventricular fibrillation?
Wait for the ICD to defibrillate the patient.
1. The possibility of microshock when handling a temporary pacemaker can be minimized by which intervention?
Wearing gloves
44. Which electrocardiographic (ECG) abnormality is most often found in ventricular dysrhythmias?
Wide QRS complexes
6. Why do women have higher mortality rates from acute myocardial infarction (MI) than men?
Women wait longer to seek medical care.
6. A nurse is providing care to a patient on fibrinolytic therapy. Which statements from the patient warrants further assessment and intervention by the nurse?
"My back is killing me!"
1. Which factors influence stroke volume? (Select all that apply, one, some, or all.)
-Afterload -Contractility -Preload
2. Which clinical manifestations are indicative of left ventricular failure? (Select all that apply, one, some, or all.)
-Cool, pale extremities -Weak peripheral pulses -Rales
3. Which mechanisms responsible for a myocardial infarction (MI)? (Select all that apply, one, some, or all.)
-Coronary artery thrombosis -Plaque rupture -Coronary artery spasm near the ruptured plaque
1. Which physiologic effects can be associated with physical exercise? (Select all that apply, one, some, or all.)
-Decreased LDL cholesterol -Increased HDL cholesterol -Decreased triglycerides -Decreased incidence of depression
4. Nursing interventions after angioplasty would include which of the following? (Select all that apply, one, some, or all.)
-Hydration as a renal protection measure -Assessing pedal pulses on the involved limb every 15 minutes for the first 2 hours after the procedure -Monitoring the vascular hemostatic device for signs of bleeding
3. Which signs and symptoms would indicate successful reperfusion after administration of a fibrinolytic agent? (Select all that apply, one, some, or all.)
-Intermittent, multifocal premature ventricular contractions -Rapid resolution of ST elevation -Rapid rise in creatine kinase MB fraction
1. Which statements describe S1, the first heart sound? (Select all that apply, one, some, or all.)
-It is associated with closure of the mitral and tricuspid valves. -It is a high-pitched sound. -It can be heard most clearly with the diaphragm of the stethoscope. -The "split" sound can best be detected in the tricuspid area.
1. A patient is diagnosed with third-degree heart failure. The nurse reviews the patient's medication list. Which classifications of drugs should be avoided with this patient? (Select all that apply, one, some, or all.)
-Nonsteroidal antiinflammatory drugs (NSAIDs) -Antidysrhythmics -Calcium channel blockers
2. Which patients would be a candidate for fibrinolytic therapy? (Select all that apply, one, some, or all.)
-The patient's chest pain started 3 hours ago, and her electrocardiogram (ECG) shows a new left bundle branch block. -The patient's chest pain started 1 hour ago, and his ECG shows ST elevation.
35. When performing a 12-lead electrocardiogram (ECG), how many wires are connected to the patient?
10
4. What is the most accurate method for monitoring the existence of true ischemic changes?
12-lead ECG
13. Which dosage of dopamine results in stimulation of beta1 receptors and increased myocardial contractility?
5 mcg/kg/min
45. The patient has a heart rate (HR) of 84 beats/min and a stroke volume (SV) of 65 mL. Calculate the cardiac output (CO).
5460 mL
11. In the acute phase after ST segment elevation myocardial infarction (STEMI), fibrinolytic therapy is used in combination with heparin to recanalize the coronary artery. What dosage is the initial heparin bolus?
60 units/kg maximum 5000 units
31. At what size is an aortic aneurysm evaluated for surgical repair or stent placement?
>5 cm
